Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD

Abstract

Objective Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life. Design From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained.

Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?

“…Our fair preparation corresponded to a Boston score of 2 and did not mean that individual colonic segments had all this score or a Boston score of 3, this latter corresponding to our excellent/good preparation. Second, the proportion of neoplastic lesions (11%) among suspicious detected lesions was in the range of other series using CE (6%–16%) 5 11 23 24. Third, the number of neoplastic lesions per-patient was not smaller in patients with dysplasia evidenced by random biopsies and the mean number of random biopsies performed per-patient with or without dysplasia in random biopsies was very close.…”

Consecutive negative findings on colonoscopy during surveillance predict a low risk of advanced neoplasia in patients with inflammatory bowel disease with long-standing colitis: results of a 15-year multicentre, multinational cohort study

“…Considering that the overall risk of CRC in IBD is decreasing over time2 13 and the sensitivity for detecting dysplasia is increasing due in part to technological advancements in neoplasia detection,14 if surveillance is maintained at overly frequent intervals in all patients with IBD, IBD surveillance programmes are at risk of becoming high-intensity/low-value cancer prevention strategies. European guidelines advocate a risk stratification model when determining appropriate surveillance intervals, but recommendations are inconsistent geographically and the data corroborating such recommendations are limited 3 5 15.…”

Imaging Inflammation and Infection in the Gastrointestinal Tract

“…To improve the surveillance of dysplasia, lesions, and other abnormalities in mucosal topography, chromoendoscopy (CE) may be used [112][113][114]. In this technique, dilute dye (indigo carmine or methylene blue) is sprayed, within appropriate guidelines, onto the lumen of the colon using a dye spray catheter [113].…”